Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Prevalence of initiation of complementary feeding at 6 months of age and associated factors among mothers of children aged 6 to 24 months in Addis Ababa, Ethiopia

Abstract Background Inappropriate complementary feeding practices are a major contributor to poor nutritional status of children under 2 years old in Ethiopia. The Ethiopian Ministry of Health recommends that continued breast feeding beyond 6 months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods. The aim of this study was to determine the prevalence of initiation of complementary feeding at 6 months of age and its associated factors among mothers of children aged 6 to 24 months in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted during January and February of 2017 among 600 mothers with children aged 6 to 24 months in Addis Ababa City. The study participants were selected using systematic random sampling technique through a multistage sampling technique. Data were collected using a pre-tested and structured questionnaire by trained data collectors. Data were entered and analyzed using EpiInfo 7 and SPSS version 21, respectively. We used multivariable binary logistic regression to model the associations of selected independent variables with initiation of complementary feeding at 6 months of age. Results Approximately 83% of mothers initiated feeding of complementary foods to their child at 6 months of age. This practice was associated with maternal education (primary education v. no education) Adjusted Odds Ratio (AOR) (95%CI): 2.26(1.19, 4.43)), and home delivery of the child (AOR (95%CI): 0.32 (0.12, 0.82)). Conclusion Most mothers in the study initiated feeding of complementary foods to their children at 6 months of age. To further improve complementary feeding practices, mothers should be educated on the benefits of introducing complementary feeding at 6 months of age and the consequences of early or late initiation of complementary feeding on child health.https://deepblue.lib.umich.edu/bitstream/2027.42/146761/1/40795_2018_Article_264.pd

Assessment of Clinical Characteristics and Outcomes of Liver Diseases Unique to Pregnancy at a Tertiary Hospital in Ethiopia: A Retrospective Cohort Study

Background. Liver disease is a rare complication of pregnancy that can lead to several consequences and require specific intervention with implications for both the mother and fetus. This study is aimed at assessing the clinical profile and associated complications of liver diseases unique to pregnancy at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methodology. This study is a retrospective cohort study of all identified cases admitted to the obstetrics ward and intensive care unit (ICU) from January 2018 to December 2020 at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Medical records were reviewed for clinical features, biochemical profiles, and fetomaternal complications. Data were analyzed using SPSS version 26. A chi-square test was done to look for an association with a p value less than 0.05 considered statistically significant, and an odds ratio was determined to assess the effect size. Results. From 95 cases identified, preeclampsia/eclampsia with liver dysfunction accounted for 43 (45%), followed by hemolysis elevated liver enzyme and low platelet (HELLP syndrome) 35 (36.8%), hyperemesis gravidarum with liver dysfunction 9 (9.5%), acute fatty liver of pregnancy (AFLP) 7 (7.4%), and intrahepatic cholestasis of pregnancy 1 (1.1%). When compared to HELLP syndrome, AFLP showed significantly higher median (IQR) values (p<0.05) for total bilirubin 13.3 (7.3-16.3), direct bilirubin 9.73 (6.87-11.9) mg/dL, prothrombin time 23 (20.4-25.7) seconds, international normalization ratio 2.2 (1.9-2.4), white blood count 23.8 (17.8-26.6)∗103/μL, creatinine 3.5 (2.44-5.6) mg/dL, and lower hemoglobin level of 7.9 (6.2-10) g/dL. There were 4 (4.2%) maternal hospital deaths, with a case fatality rate of HELLP syndrome being 8.6% and 14.3% in AFLP. The overall hospital fetal mortality was 33 (34.7%). In this study, 42 patients with HELLP syndrome and AFLP had an increased risk of maternal ICU admission (OR=25.5, 95% CI: 5.48-118.6, p value = 0.001), acute kidney injury requiring dialysis (OR=12.2, 95% CI: 1.46-102.2, p value = 0.009), placental abruption (OR=14.2, 95% CI: 1.72-117.1, p value = 0.004), and stillbirth (OR=7.2, 95% CI: 2.38-21.7, p value = 0.001). Conclusion. Preeclampsia with liver dysfunction and HELLP syndrome accounted for the majority of cases. It also demonstrated key biochemical characteristics that can be used to distinguish between HELLP syndrome and AFLP. Emphasis has to be given to the risk of requiring maternal ICU admission, dialysis, abruption of the placenta, and stillbirths while managing patients diagnosed with HELLP syndrome and AFLP

Prevalence of visual impairment among school children in three primary schools of Sekela Woreda, Amhara regional state, north-west Ethiopia

Background: Although there are limited studies, recent data are lacking to determine the prevalence of eye problems in Ethiopia accurately and there is no scientific evidence of such study in Sekela Woreda. The purpose of this study was to determine the prevalence of visual impairment among school children in Sekela Woreda, Ethiopia. Methods: The study design was a community-based analytical cross-sectional with a multi-stage cluster random sampling technique from September to November 2016.Visual acuity was tested using Snellen’s “E” chart while color vision was tested using Ishihara chart. The data were analyzed using SPSS version 20 software, and binary logistic regression was used to identify factors associated with visual impairment. Results: A total of 875 participants, 466 (53.3%) males and 409 (46.7%) females, with an age range of 8–18 years were screened for visual acuity and color vision deficiency. The prevalence of visual impairment (visual acuity ⩽ 6/12) in “either eye” was 70 (8.0%). Among these, 37 (52.9%) were males and 33 (41.1%) were females. The prevalence of low vision (visual acuity ≤ 6 / 36 ) and blindness (visual acuity < 3/60) in “either eye” were 28 (3.2%) and 10 (1.1%), respectively. Thirty two (3.7%) had mild visual impairment ( v i s u a l a c u i t y ≤ 6 / 12 t o ≥ 6 / 18 ) . The prevalence of color vision deficiency was 36 (4.1%). Among these, 27 (3%) were males and 9 (1.1%) were females. The variables age (adjusted odds ratio (95% confidence interval) = 1.14 (1.01–1.28) and color blindness (adjusted odds ratio (95% confidence interval) = 3.93(1.69–9.09) were significantly associated with visual impairment. Conclusion: The prevalence of blindness and low vision in school children were higher than the national prevalence in Ethiopia. Increasing age and color defective vision were factors associated with the children’s visual impairment. The Woreda health office ought to work with responsible stakeholders to tackle the situation in early childhood

Drug-Resistant tuberculosis in Ethiopia: Characteristics of cases in a referral hospital and the implications

Background: Tuberculosis (TB) programs should design intervention strategies based on the sound knowledge of the existing local epidemiology and sociodemographic characteristics of drug-resistant-TB (DR-TB) cases. The aim of the study was to characterize the pulmonary multidrug-resistant (MDR) and rifampicin-resistant (RR) TB cases enrolled in a referral hospital at Addis Ababa, Ethiopia, called All Africa Leprosy, Tuberculosis, Rehabilitation and Training (ALERT) Hospital. Methods: We conducted a descriptive study based on retrospective review of medical records of 340 pulmonary MDR/RR-TB cases enrolled in ALERT Hospital from November 2011 to December 2016. To characterize the cases, we described the distribution of demographic and clinical characteristics. To compare the distribution of demographic and clinical characteristics between male and female cases, we used Pearson's Chi-squared test. Results: Males accounted for 52.9% of the 340 cases. Nine out of ten cases were in the age group of 15–44 years. Sputum acid-fast bacilli smear-positive and human immunodeficiency virus-coinfected cases constituted 63.7% and 18.1% of cases, respectively. The proportion of new cases increased through the years from nil in 2011 to 21.4% in 2016. Adult males above 24 years constituted more than three quarters (77.2%) of the total male cases, while adult females in this age group constituted 56.9%. The age distribution between male and female cases showed significant differences (P < 0.001). Conclusion: There is age disparity between male and female cases with high impact of MDR/RR-TB on productive adult male population. The transmission potential for DR-TB is also high in the community

Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia

Abstract Background Post-traumatic stress disorder is the most common mental disorders occurring among survivors of road traffic accident. However, research into post-traumatic stress disorder and correlates in low and middle-income countries is limited. To the best of our knowledge, there is no published study of the post-traumatic stress disorder and associated factors conducted in Ethiopia. Therefore, this study aimed to determine the prevalence of post-traumatic stress disorder and associated factors among survivors of road traffic accident. Methods Institution based cross-sectional study was conducted in May 2016. Data were collected using a pretested, structured, standardized post-traumatic stress disorder Checklist-Specific version (PCL-S) questionnaire. Systematic sampling technique was used to select the study participants. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of associations. Results The prevalence of post-traumatic stress disorder was found to be 22.8% (CI 19.2, 26.6) among survivors of road traffic accident. In the multivariable analysis, Being female [AOR = 2.23, 95% CI 1.40, 3.56], having poor social support [AOR = 2.1, 95% CI 1.34, 3.46], duration since accident (1–3 months) [AOR = 1.72, 95% CI 1.07, 2.76] and having depression [AOR = 3.46, 95% CI 1.99, 5.99] were significantly associated with PTSD among survivors of road traffic accident. Conclusion In the current study the magnitude of post-traumatic stress disorder was high. Being female, poor social support, duration since the accident (1–3 months) and depression were found to be significant predictors of post-traumatic stress disorders. The finding suggests a need for early screening for post-traumatic disorder among survivors of road traffic accidents

Inflammatory mediators profile in patients hospitalized with COVID-19 : A comparative study

Abnormal inflammatory mediator concentrations during SARS-CoV-2 infection may represent disease severity. We aimed to assess plasma inflammatory mediator concentrations in patients with SARS-CoV-2 in Addis Ababa, Ethiopia. In this study, 260 adults: 126 hospitalized patients with confirmed COVID-19 sorted into severity groups: severe (n=68) and mild or moderate (n=58), and 134 healthy controls were enrolled. We quantified 39 plasma inflammatory mediators using multiplex ELISA. Spearman rank correlation and Mann-Whitney U test were used to identify mechanistically coupled inflammatory mediators and compare disease severity. Compared to healthy controls, patients with COVID-19 had significantly higher levels of interleukins 1α, 2, 6, 7, 8, 10 and 15, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1 (VCAM-1), IFN-γ-inducible protein-10 (IP-10, CXCL10), macrophage inflammatory protein-1 alpha (MIP-1α, CCL3), eotaxin-3 (CCL26), interferon-gamma (IFN-γ), tumor necrosis factor-α (TNF-α), basic fibroblast growth factor (bFGF), placental growth factor (PlGF), and fms-like tyrosine kinase 1 (Flt-1). Patients with severe COVID-19 had higher IL-10 and lower macrophage-derived chemokine (MDC, CCL22) compared to the mild or moderate group (P&lt;0.05). In the receiver operating characteristic curve, SAA, IL-6 and CRP showed strong sensitivity and specificity in predicting the severity and prognosis of COVID-19. Greater age and higher CRP had a significant association with disease severity (P&lt;0.05). Our findings reveal that CRP, SAA, VCAM-1, CXCL10, CCL22 and IL-10 levels are promising biomarkers for COVID-19 disease severity, suggesting that plasma inflammatory mediators could be used as warning indicators of COVID-19 severity, aid in COVID-19 prognosis and treatment

Survival and prognostic determinants of prostate cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A retrospective cohort study.

BACKGROUND:Globally, the incidence of prostate cancer is increasing, particularly in low- and middle-income countries. It is the most common cancer among men worldwide, with higher mortality in low and middle-income countries. In Ethiopia, it is the second most common cause of cancer morbidity and mortality among men. Despite a few studies done regarding the disease burden, the evidence is scarce about the survival and prognostic determinants of prostate cancer patients in Ethiopia. Thus, this study assessed the survival and prognostic determinants of patients with prostate cancer. METHODS:We retrospectively followed patients who were newly diagnosed from 2012 to 2016 at the Oncology Department of Tikur Anbessa Specialized Hospital. We extracted the data from patient charts that were available in the cancer registry using a checklist with the help of oncology nurses. Kaplan-Meier survival analyses with the log-rank test were used to estimate and compare the probability of survival among covariate categories. After checking for assumptions, a multivariable Cox regression analysis was performed to identify prognostic determinants of survival. RESULTS:The median survival time was 28 months with an overall 2-, 3- and 5-year survival of 57%, 38.9% and 22%, respectively. The overall survival differs according to the clinical stage (P-value<0.01), presence or absence of distant metastasis (P<0.01) and androgen deprivation therapy (ADT) (P<0.05). Cancer stage at diagnosis (adjusted hazard ratio (AHR) = 0.309, 95%CI = 0.151-0.633) and ADT (AHR = 3.884, 95%CI = 1.677-8.997) remained significant in the final Cox proportional hazards model. CONCLUSIONS:The overall 2-, 3- and 5-year survival of prostate cancer patients in Ethiopia is very low. The cancer stage at diagnosis and treatment modalities are significant prognostic determinants of survival. Therefore, early detection through screening and timely initiation of treatment are essential to improve the survival of prostate cancer patients

Women’s satisfaction with intrapartum care in St Paul’s Hospital Millennium Medical College Addis Ababa Ethiopia: a cross sectional study

Abstract Background Satisfaction during intrapartum care is the most influential attribute on maternal health service return behaviors and utilization. Measuring satisfaction of women with intrapartum care helps to address the problems and improves the quality of delivery services. The aim of this study is to assess women’s level of satisfaction during intrapartum care. Method A hospital based, analytic, cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa Ethiopia, from May to June 2015. Data collectors administered a structured and pretested questionnaire to collect data and then analyzed it using SPSS version 20.0 software. Binary logistic regression was used to identify factors associated with women’s intrapartum care satisfaction. Result A total of 394 women of mean age 25.98 years with a standard deviation of ±4.72were included in the study. Only 19% of the women were satisfied with the intrapartum care they received. The variables which were significantly associated with satisfaction of intrapartum care were; opportunity to talk Adjusted Odds Ratio (AOR) (95% CI) 2.44 (1.12, 5.29); Pain Management AOR (95% CI) 3.37 (1.83, 6.21); Short Length of Time Taken for Admission After Seen by Health Professionals AOR (95% CI)0 .97 (0.93, 0.99), and Short Length of Stay in the Hospital AOR (95% CI) 0.91 (0.87, 0.96). Conclusions The women’s overall satisfaction with intrapartum care was low. Multiple factors influence their satisfaction. Health professionals, policy makers and health administrators should give emphasis to factors that contribute to low satisfaction of women with intrapartum care. They should also strengthen their efforts to deliver quality and easily accessible maternal health service to improve women’s overall satisfaction with the maternal health service

Helicobacter pylori Infection as a Risk Factor for Hepatocellular Carcinoma: A Case-Control Study in Ethiopia

Background and Aims. Hepatocellular carcinoma is a major cause of cancer death worldwide, accounting for over half a million deaths per year. Its incidence varies with geographic locations and the type of etiologic factors. In Ethiopia, unidentified causes of liver disease are of sizeable proportion. Recent studies have shown an association of H. pylori infection with different spectrums of chronic liver disease. This study was conducted at St. Paul’s Hospital Millennium Medical College in Ethiopia and assesses liver cancer and the association with H. pylori infection. Method. A prospective case-control study conducted on patients with chronic liver disease presenting with a suspicious liver lesion and diagnosed to have HCC in the Gastrointestinal (GI) Clinic of St. Paul’s Hospital MMC from Dec 30, 2016, to Nov 1, 2017 G.C. Descriptive surveys on clinical history and physical examination and laboratory profiles were obtained, and the clinical course of the patients including the type of treatment was followed prospectively. Control cases were taken from adult patients without evidence of liver disease in the internal medicine clinic coming for routine evaluation. After collection data were analyzed using SPSS version 23 and associations were assessed using chi-square test. Binary logistic regression was used to assess the association of HCC with different variables and H. pylori infection. All variables with p-value <0.05 were considered as statistically significant. Results. One hundred twenty patients were analyzed with equal representation of cases and controls. The majority of patients with HCC were male with a mean age of 36 years. Older age adjusted Odds Ratio (AOR) (95%CI, p-value) 1.07(1.03-1.09, <0.001), viral hepatitis B (AOR) (95%CI, p-value) 6.19 (1.92-19.93, 0.002), and H. pylori infection (AOR) (95%CI, p-value) 5.22 (2.04–13.31, <0.001) were statistically significantly associated with HCC. Conclusion. H. pylori infection is associated with HCC in this case-control study. This study supports the emerging evidence of H. pylori association with other extra-gastric manifestations